|
HC EPHYS EVAL CCM DFIB LD INITIAL IMPL
|
Facility
|
OP
|
$3,315.00
|
|
|
Service Code
|
CPT 0930T
|
| Hospital Charge Code |
906811514
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$663.00 |
| Max. Negotiated Rate |
$8,136.21 |
| Rate for Payer: Adventist Health Commercial |
$663.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,565.96
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,013.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,348.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,722.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,565.96
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,605.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,928.34
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$1,491.75
|
| Rate for Payer: Cash Price |
$1,491.75
|
| Rate for Payer: Cash Price |
$1,491.75
|
| Rate for Payer: Cash Price |
$1,491.75
|
| Rate for Payer: Central Health Plan Commercial |
$2,652.00
|
| Rate for Payer: Cigna of CA HMO |
$2,121.60
|
| Rate for Payer: Cigna of CA PPO |
$2,453.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,348.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,722.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,565.96
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,320.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,583.83
|
| Rate for Payer: EPIC Health Plan Senior |
$1,722.56
|
| Rate for Payer: Galaxy Health WC |
$2,817.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,989.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,983.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,568.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,565.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,105.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,203.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,192.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$663.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,098.39
|
| Rate for Payer: Multiplan Commercial |
$2,486.25
|
| Rate for Payer: Networks By Design Commercial |
$2,154.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,565.96
|
| Rate for Payer: Prime Health Services Commercial |
$2,817.75
|
| Rate for Payer: Prime Health Services Medicare |
$1,659.92
|
| Rate for Payer: Riverside University Health System MISP |
$1,722.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,989.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,989.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,565.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,348.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,722.56
|
| Rate for Payer: Vantage Medical Group Senior |
$1,565.96
|
|
|
HC EPHYS EVAL CCM DFIB LD SEPARATE
|
Facility
|
OP
|
$3,315.00
|
|
|
Service Code
|
CPT 0931T
|
| Hospital Charge Code |
906811515
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$663.00 |
| Max. Negotiated Rate |
$8,136.21 |
| Rate for Payer: Adventist Health Commercial |
$663.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,565.96
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,013.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,348.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,722.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,565.96
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,605.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,928.34
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$1,491.75
|
| Rate for Payer: Cash Price |
$1,491.75
|
| Rate for Payer: Cash Price |
$1,491.75
|
| Rate for Payer: Cash Price |
$1,491.75
|
| Rate for Payer: Central Health Plan Commercial |
$2,652.00
|
| Rate for Payer: Cigna of CA HMO |
$2,121.60
|
| Rate for Payer: Cigna of CA PPO |
$2,453.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,348.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,722.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,565.96
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,320.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,583.83
|
| Rate for Payer: EPIC Health Plan Senior |
$1,722.56
|
| Rate for Payer: Galaxy Health WC |
$2,817.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,989.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,983.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,568.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,565.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,105.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,203.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,192.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$663.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,098.39
|
| Rate for Payer: Multiplan Commercial |
$2,486.25
|
| Rate for Payer: Networks By Design Commercial |
$2,154.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,565.96
|
| Rate for Payer: Prime Health Services Commercial |
$2,817.75
|
| Rate for Payer: Prime Health Services Medicare |
$1,659.92
|
| Rate for Payer: Riverside University Health System MISP |
$1,722.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,989.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,989.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,565.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,348.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,722.56
|
| Rate for Payer: Vantage Medical Group Senior |
$1,565.96
|
|
|
HC EPHYS EVAL CCM DFIB LD SEPARATE
|
Facility
|
IP
|
$3,315.00
|
|
|
Service Code
|
CPT 0931T
|
| Hospital Charge Code |
906811515
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$663.00 |
| Max. Negotiated Rate |
$2,983.50 |
| Rate for Payer: Adventist Health Commercial |
$663.00
|
| Rate for Payer: Cash Price |
$1,491.75
|
| Rate for Payer: Central Health Plan Commercial |
$2,652.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,320.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,326.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,326.00
|
| Rate for Payer: Galaxy Health WC |
$2,817.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,989.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,983.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,105.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,955.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$663.00
|
| Rate for Payer: Multiplan Commercial |
$2,486.25
|
| Rate for Payer: Networks By Design Commercial |
$2,154.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,817.75
|
|
|
HC EPIDRM AGRFT TRNK ARM LEG LT 100
|
Facility
|
IP
|
$6,284.00
|
|
|
Service Code
|
CPT 15110
|
| Hospital Charge Code |
900501779
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,256.80 |
| Max. Negotiated Rate |
$5,655.60 |
| Rate for Payer: Adventist Health Commercial |
$1,256.80
|
| Rate for Payer: Cash Price |
$2,827.80
|
| Rate for Payer: Central Health Plan Commercial |
$5,027.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,398.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,513.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,513.60
|
| Rate for Payer: Galaxy Health WC |
$5,341.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,770.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,655.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,990.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,707.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,256.80
|
| Rate for Payer: Multiplan Commercial |
$4,713.00
|
| Rate for Payer: Networks By Design Commercial |
$4,084.60
|
| Rate for Payer: Prime Health Services Commercial |
$5,341.40
|
|
|
HC EPIDRM AGRFT TRNK ARM LEG LT 100
|
Facility
|
OP
|
$6,284.00
|
|
|
Service Code
|
CPT 15110
|
| Hospital Charge Code |
900501779
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$6,587.00 |
| Rate for Payer: Adventist Health Commercial |
$1,256.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,980.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,919.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,653.72
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,703.23
|
| Rate for Payer: Cash Price |
$2,827.80
|
| Rate for Payer: Cash Price |
$2,827.80
|
| Rate for Payer: Cash Price |
$2,827.80
|
| Rate for Payer: Cash Price |
$2,827.80
|
| Rate for Payer: Central Health Plan Commercial |
$5,027.20
|
| Rate for Payer: Cigna of CA HMO |
$4,021.76
|
| Rate for Payer: Cigna of CA PPO |
$4,650.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,980.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,919.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,653.72
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,398.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,378.64
|
| Rate for Payer: EPIC Health Plan Senior |
$2,919.09
|
| Rate for Payer: Galaxy Health WC |
$5,341.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,770.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,655.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,352.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,653.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,990.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,266.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,852.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,256.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,555.98
|
| Rate for Payer: Multiplan Commercial |
$4,713.00
|
| Rate for Payer: Multiplan WC |
$3,703.23
|
| Rate for Payer: Networks By Design Commercial |
$4,084.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,653.72
|
| Rate for Payer: Preferred Health Network WC |
$3,778.81
|
| Rate for Payer: Prime Health Services Commercial |
$5,341.40
|
| Rate for Payer: Prime Health Services Medicare |
$2,812.94
|
| Rate for Payer: Prime Health Services WC |
$3,665.45
|
| Rate for Payer: Riverside University Health System MISP |
$2,919.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,770.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,142.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,142.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,142.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,142.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,653.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,980.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,919.09
|
| Rate for Payer: Vantage Medical Group Senior |
$2,653.72
|
|
|
HC EPIDURAL INJECT BLOOD PATCH
|
Facility
|
IP
|
$3,571.00
|
|
|
Service Code
|
CPT 62273
|
| Hospital Charge Code |
902400135
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$714.20 |
| Max. Negotiated Rate |
$3,213.90 |
| Rate for Payer: Adventist Health Commercial |
$714.20
|
| Rate for Payer: Cash Price |
$1,606.95
|
| Rate for Payer: Central Health Plan Commercial |
$2,856.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,499.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,428.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,428.40
|
| Rate for Payer: Galaxy Health WC |
$3,035.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,142.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,213.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,267.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,106.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$714.20
|
| Rate for Payer: Multiplan Commercial |
$2,678.25
|
| Rate for Payer: Networks By Design Commercial |
$2,321.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,035.35
|
|
|
HC EPIDURAL INJECT BLOOD PATCH
|
Facility
|
OP
|
$3,571.00
|
|
|
Service Code
|
CPT 62273
|
| Hospital Charge Code |
906562273
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$130.63 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$714.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$907.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$622.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,361.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$998.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$907.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,264.01
|
| Rate for Payer: Blue Shield of California EPN |
$1,424.83
|
| Rate for Payer: Cash Price |
$1,606.95
|
| Rate for Payer: Cash Price |
$1,606.95
|
| Rate for Payer: Cash Price |
$1,606.95
|
| Rate for Payer: Cash Price |
$1,606.95
|
| Rate for Payer: Central Health Plan Commercial |
$2,856.80
|
| Rate for Payer: Cigna of CA HMO |
$2,285.44
|
| Rate for Payer: Cigna of CA PPO |
$2,642.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,361.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$998.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$907.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,499.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,498.00
|
| Rate for Payer: EPIC Health Plan Senior |
$998.67
|
| Rate for Payer: Galaxy Health WC |
$3,035.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,142.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,213.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,488.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$130.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$907.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,267.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$144.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,271.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$714.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,216.56
|
| Rate for Payer: Multiplan Commercial |
$2,678.25
|
| Rate for Payer: Networks By Design Commercial |
$2,321.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$907.88
|
| Rate for Payer: Prime Health Services Commercial |
$3,035.35
|
| Rate for Payer: Prime Health Services Medicare |
$962.35
|
| Rate for Payer: Riverside University Health System MISP |
$998.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,142.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,142.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,091.00
|
| Rate for Payer: United Healthcare All Other HMO |
$839.00
|
| Rate for Payer: United Healthcare HMO Rider |
$635.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$581.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$907.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,361.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$998.67
|
| Rate for Payer: Vantage Medical Group Senior |
$907.88
|
|
|
HC EPIDURAL INJECT BLOOD PATCH
|
Facility
|
IP
|
$3,571.00
|
|
|
Service Code
|
CPT 62273
|
| Hospital Charge Code |
906562273
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$714.20 |
| Max. Negotiated Rate |
$3,213.90 |
| Rate for Payer: Adventist Health Commercial |
$714.20
|
| Rate for Payer: Cash Price |
$1,606.95
|
| Rate for Payer: Central Health Plan Commercial |
$2,856.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,499.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,428.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,428.40
|
| Rate for Payer: Galaxy Health WC |
$3,035.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,142.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,213.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,267.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,106.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$714.20
|
| Rate for Payer: Multiplan Commercial |
$2,678.25
|
| Rate for Payer: Networks By Design Commercial |
$2,321.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,035.35
|
|
|
HC EPIDURAL INJECT BLOOD PATCH
|
Facility
|
OP
|
$3,571.00
|
|
|
Service Code
|
CPT 62273
|
| Hospital Charge Code |
902400135
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$144.31 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$1,464.11
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$622.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,361.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$998.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$907.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,402.00
|
| Rate for Payer: Cash Price |
$1,606.95
|
| Rate for Payer: Cash Price |
$1,606.95
|
| Rate for Payer: Cash Price |
$1,606.95
|
| Rate for Payer: Cash Price |
$1,606.95
|
| Rate for Payer: Central Health Plan Commercial |
$2,856.80
|
| Rate for Payer: Cigna of CA HMO |
$2,285.44
|
| Rate for Payer: Cigna of CA PPO |
$2,642.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,361.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$998.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$907.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,499.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,498.00
|
| Rate for Payer: EPIC Health Plan Senior |
$998.67
|
| Rate for Payer: Galaxy Health WC |
$3,035.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,142.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,213.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,488.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$907.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,267.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$144.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$975.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$714.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,216.56
|
| Rate for Payer: Multiplan Commercial |
$2,678.25
|
| Rate for Payer: Multiplan WC |
$1,402.00
|
| Rate for Payer: Networks By Design Commercial |
$2,321.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$907.88
|
| Rate for Payer: Preferred Health Network WC |
$1,430.61
|
| Rate for Payer: Prime Health Services Commercial |
$3,035.35
|
| Rate for Payer: Prime Health Services Medicare |
$962.35
|
| Rate for Payer: Prime Health Services WC |
$1,387.69
|
| Rate for Payer: Riverside University Health System MISP |
$998.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,142.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,142.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$907.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,361.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$998.67
|
| Rate for Payer: Vantage Medical Group Senior |
$907.88
|
|
|
HC EPIDURAL INJECT BLOOD PATCH
|
Facility
|
OP
|
$3,571.00
|
|
|
Service Code
|
CPT 62273
|
| Hospital Charge Code |
902400135
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$130.63 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$714.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$907.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$622.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,361.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$998.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$907.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,264.01
|
| Rate for Payer: Blue Shield of California EPN |
$1,424.83
|
| Rate for Payer: Cash Price |
$1,606.95
|
| Rate for Payer: Cash Price |
$1,606.95
|
| Rate for Payer: Cash Price |
$1,606.95
|
| Rate for Payer: Cash Price |
$1,606.95
|
| Rate for Payer: Central Health Plan Commercial |
$2,856.80
|
| Rate for Payer: Cigna of CA HMO |
$2,285.44
|
| Rate for Payer: Cigna of CA PPO |
$2,642.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,361.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$998.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$907.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,499.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,498.00
|
| Rate for Payer: EPIC Health Plan Senior |
$998.67
|
| Rate for Payer: Galaxy Health WC |
$3,035.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,142.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,213.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,488.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$130.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$907.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,267.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$144.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,271.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$714.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,216.56
|
| Rate for Payer: Multiplan Commercial |
$2,678.25
|
| Rate for Payer: Networks By Design Commercial |
$2,321.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$907.88
|
| Rate for Payer: Prime Health Services Commercial |
$3,035.35
|
| Rate for Payer: Prime Health Services Medicare |
$962.35
|
| Rate for Payer: Riverside University Health System MISP |
$998.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,142.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,142.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,091.00
|
| Rate for Payer: United Healthcare All Other HMO |
$839.00
|
| Rate for Payer: United Healthcare HMO Rider |
$635.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$581.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$907.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,361.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$998.67
|
| Rate for Payer: Vantage Medical Group Senior |
$907.88
|
|
|
HC EPIDURAL INJECT BLOOD PATCH
|
Facility
|
OP
|
$3,571.00
|
|
|
Service Code
|
CPT 62273
|
| Hospital Charge Code |
902400135
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$144.31 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$714.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,361.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$998.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$907.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,402.00
|
| Rate for Payer: Cash Price |
$1,606.95
|
| Rate for Payer: Cash Price |
$1,606.95
|
| Rate for Payer: Cash Price |
$1,606.95
|
| Rate for Payer: Cash Price |
$1,606.95
|
| Rate for Payer: Central Health Plan Commercial |
$2,856.80
|
| Rate for Payer: Cigna of CA HMO |
$2,285.44
|
| Rate for Payer: Cigna of CA PPO |
$2,642.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,361.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$998.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$907.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,499.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,498.00
|
| Rate for Payer: EPIC Health Plan Senior |
$998.67
|
| Rate for Payer: Galaxy Health WC |
$3,035.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,142.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,213.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,488.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$907.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,267.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$144.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$975.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$714.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,216.56
|
| Rate for Payer: Multiplan Commercial |
$2,678.25
|
| Rate for Payer: Multiplan WC |
$1,402.00
|
| Rate for Payer: Networks By Design Commercial |
$2,321.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$907.88
|
| Rate for Payer: Preferred Health Network WC |
$1,430.61
|
| Rate for Payer: Prime Health Services Commercial |
$3,035.35
|
| Rate for Payer: Prime Health Services Medicare |
$962.35
|
| Rate for Payer: Prime Health Services WC |
$1,387.69
|
| Rate for Payer: Riverside University Health System MISP |
$998.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,142.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,785.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,785.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,785.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,785.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$907.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,361.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$998.67
|
| Rate for Payer: Vantage Medical Group Senior |
$907.88
|
|
|
HC EPIDURAL INJECT BLOOD PATCH
|
Facility
|
IP
|
$3,571.00
|
|
|
Service Code
|
CPT 62273
|
| Hospital Charge Code |
902400135
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$714.20 |
| Max. Negotiated Rate |
$3,213.90 |
| Rate for Payer: Adventist Health Commercial |
$714.20
|
| Rate for Payer: Cash Price |
$1,606.95
|
| Rate for Payer: Central Health Plan Commercial |
$2,856.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,499.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,428.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,428.40
|
| Rate for Payer: Galaxy Health WC |
$3,035.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,142.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,213.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,267.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,106.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$714.20
|
| Rate for Payer: Multiplan Commercial |
$2,678.25
|
| Rate for Payer: Networks By Design Commercial |
$2,321.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,035.35
|
|
|
HC EPIDURAL INJECT BLOOD PATCH
|
Facility
|
IP
|
$3,571.00
|
|
|
Service Code
|
CPT 62273
|
| Hospital Charge Code |
902400135
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$714.20 |
| Max. Negotiated Rate |
$3,213.90 |
| Rate for Payer: Adventist Health Commercial |
$714.20
|
| Rate for Payer: Cash Price |
$1,606.95
|
| Rate for Payer: Central Health Plan Commercial |
$2,856.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,499.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,428.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,428.40
|
| Rate for Payer: Galaxy Health WC |
$3,035.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,142.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,213.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,267.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,106.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$714.20
|
| Rate for Payer: Multiplan Commercial |
$2,678.25
|
| Rate for Payer: Networks By Design Commercial |
$2,321.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,035.35
|
|
|
HC EPIFIX 2X3
|
Facility
|
OP
|
$383.00
|
|
|
Service Code
|
CPT Q4186 JW
|
| Hospital Charge Code |
900101471
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$76.60 |
| Max. Negotiated Rate |
$981.22 |
| Rate for Payer: Adventist Health Commercial |
$76.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$981.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$325.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$210.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$287.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$185.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$222.79
|
| Rate for Payer: Blue Shield of California Commercial |
$242.82
|
| Rate for Payer: Blue Shield of California EPN |
$152.82
|
| Rate for Payer: Cash Price |
$172.35
|
| Rate for Payer: Cash Price |
$172.35
|
| Rate for Payer: Central Health Plan Commercial |
$306.40
|
| Rate for Payer: Cigna of CA HMO |
$268.10
|
| Rate for Payer: Cigna of CA PPO |
$268.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$325.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$325.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$325.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$268.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.20
|
| Rate for Payer: EPIC Health Plan Senior |
$153.20
|
| Rate for Payer: Galaxy Health WC |
$325.55
|
| Rate for Payer: Global Benefits Group Commercial |
$229.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$344.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$260.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$243.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$288.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$225.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$268.10
|
| Rate for Payer: Multiplan Commercial |
$287.25
|
| Rate for Payer: Networks By Design Commercial |
$191.50
|
| Rate for Payer: Prime Health Services Commercial |
$325.55
|
| Rate for Payer: Riverside University Health System MISP |
$153.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$229.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$229.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$143.74
|
| Rate for Payer: United Healthcare All Other HMO |
$139.91
|
| Rate for Payer: United Healthcare HMO Rider |
$136.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$125.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$325.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$325.55
|
| Rate for Payer: Vantage Medical Group Senior |
$325.55
|
|
|
HC EPIFIX 2X3
|
Facility
|
IP
|
$383.00
|
|
|
Service Code
|
CPT Q4186 JW
|
| Hospital Charge Code |
900101471
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$76.60 |
| Max. Negotiated Rate |
$344.70 |
| Rate for Payer: Adventist Health Commercial |
$76.60
|
| Rate for Payer: Blue Shield of California Commercial |
$307.17
|
| Rate for Payer: Blue Shield of California EPN |
$193.03
|
| Rate for Payer: Cash Price |
$172.35
|
| Rate for Payer: Central Health Plan Commercial |
$306.40
|
| Rate for Payer: Cigna of CA HMO |
$268.10
|
| Rate for Payer: Cigna of CA PPO |
$268.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$268.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.20
|
| Rate for Payer: EPIC Health Plan Senior |
$153.20
|
| Rate for Payer: Galaxy Health WC |
$325.55
|
| Rate for Payer: Global Benefits Group Commercial |
$229.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$344.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$243.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$225.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.60
|
| Rate for Payer: Multiplan Commercial |
$287.25
|
| Rate for Payer: Networks By Design Commercial |
$191.50
|
| Rate for Payer: Prime Health Services Commercial |
$325.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$143.74
|
| Rate for Payer: United Healthcare All Other HMO |
$139.91
|
| Rate for Payer: United Healthcare HMO Rider |
$136.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$125.43
|
|
|
HC EP RF BIO/WEB COOL FLOW TUBING
|
Facility
|
OP
|
$481.00
|
|
| Hospital Charge Code |
906812736
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$96.20 |
| Max. Negotiated Rate |
$432.90 |
| Rate for Payer: Adventist Health Commercial |
$96.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$292.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$408.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$264.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$360.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$232.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$279.80
|
| Rate for Payer: Blue Shield of California Commercial |
$304.95
|
| Rate for Payer: Blue Shield of California EPN |
$191.92
|
| Rate for Payer: Cash Price |
$216.45
|
| Rate for Payer: Central Health Plan Commercial |
$384.80
|
| Rate for Payer: Cigna of CA HMO |
$307.84
|
| Rate for Payer: Cigna of CA PPO |
$355.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$408.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$408.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$408.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$336.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$192.40
|
| Rate for Payer: EPIC Health Plan Senior |
$192.40
|
| Rate for Payer: Galaxy Health WC |
$408.85
|
| Rate for Payer: Global Benefits Group Commercial |
$288.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$432.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$305.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$174.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$283.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$336.70
|
| Rate for Payer: Multiplan Commercial |
$360.75
|
| Rate for Payer: Networks By Design Commercial |
$312.65
|
| Rate for Payer: Prime Health Services Commercial |
$408.85
|
| Rate for Payer: Riverside University Health System MISP |
$192.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$288.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$288.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$240.50
|
| Rate for Payer: United Healthcare All Other HMO |
$240.50
|
| Rate for Payer: United Healthcare HMO Rider |
$240.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$240.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$408.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$408.85
|
| Rate for Payer: Vantage Medical Group Senior |
$408.85
|
|
|
HC EP RF BIO/WEB COOL FLOW TUBING
|
Facility
|
IP
|
$481.00
|
|
| Hospital Charge Code |
906812736
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$96.20 |
| Max. Negotiated Rate |
$432.90 |
| Rate for Payer: Adventist Health Commercial |
$96.20
|
| Rate for Payer: Cash Price |
$216.45
|
| Rate for Payer: Central Health Plan Commercial |
$384.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$336.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$192.40
|
| Rate for Payer: EPIC Health Plan Senior |
$192.40
|
| Rate for Payer: Galaxy Health WC |
$408.85
|
| Rate for Payer: Global Benefits Group Commercial |
$288.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$432.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$305.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$283.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.20
|
| Rate for Payer: Multiplan Commercial |
$360.75
|
| Rate for Payer: Networks By Design Commercial |
$312.65
|
| Rate for Payer: Prime Health Services Commercial |
$408.85
|
|
|
HC EP RF CRYO CO-AXIAL TUBING
|
Facility
|
IP
|
$418.00
|
|
| Hospital Charge Code |
906812330
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$83.60 |
| Max. Negotiated Rate |
$376.20 |
| Rate for Payer: Adventist Health Commercial |
$83.60
|
| Rate for Payer: Cash Price |
$188.10
|
| Rate for Payer: Central Health Plan Commercial |
$334.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$292.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$167.20
|
| Rate for Payer: EPIC Health Plan Senior |
$167.20
|
| Rate for Payer: Galaxy Health WC |
$355.30
|
| Rate for Payer: Global Benefits Group Commercial |
$250.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$376.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$265.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$246.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.60
|
| Rate for Payer: Multiplan Commercial |
$313.50
|
| Rate for Payer: Networks By Design Commercial |
$271.70
|
| Rate for Payer: Prime Health Services Commercial |
$355.30
|
|
|
HC EP RF CRYO CO-AXIAL TUBING
|
Facility
|
OP
|
$418.00
|
|
| Hospital Charge Code |
906812330
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$83.60 |
| Max. Negotiated Rate |
$376.20 |
| Rate for Payer: Adventist Health Commercial |
$83.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$253.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$355.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$229.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$313.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$202.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$243.15
|
| Rate for Payer: Blue Shield of California Commercial |
$265.01
|
| Rate for Payer: Blue Shield of California EPN |
$166.78
|
| Rate for Payer: Cash Price |
$188.10
|
| Rate for Payer: Central Health Plan Commercial |
$334.40
|
| Rate for Payer: Cigna of CA HMO |
$267.52
|
| Rate for Payer: Cigna of CA PPO |
$309.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$355.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$355.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$355.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$292.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$167.20
|
| Rate for Payer: EPIC Health Plan Senior |
$167.20
|
| Rate for Payer: Galaxy Health WC |
$355.30
|
| Rate for Payer: Global Benefits Group Commercial |
$250.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$376.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$265.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$151.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$246.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$292.60
|
| Rate for Payer: Multiplan Commercial |
$313.50
|
| Rate for Payer: Networks By Design Commercial |
$271.70
|
| Rate for Payer: Prime Health Services Commercial |
$355.30
|
| Rate for Payer: Riverside University Health System MISP |
$167.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$250.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$250.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$209.00
|
| Rate for Payer: United Healthcare All Other HMO |
$209.00
|
| Rate for Payer: United Healthcare HMO Rider |
$209.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$209.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$355.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$355.30
|
| Rate for Payer: Vantage Medical Group Senior |
$355.30
|
|
|
HC EP RF STJ SAFIRE ABLAT CATH
|
Facility
|
IP
|
$3,198.00
|
|
|
Service Code
|
CPT C1733
|
| Hospital Charge Code |
906812342
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$639.60 |
| Max. Negotiated Rate |
$2,878.20 |
| Rate for Payer: Adventist Health Commercial |
$639.60
|
| Rate for Payer: Cash Price |
$1,439.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,558.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,238.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,279.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,279.20
|
| Rate for Payer: Galaxy Health WC |
$2,718.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,918.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,878.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,030.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,886.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$639.60
|
| Rate for Payer: Multiplan Commercial |
$2,398.50
|
| Rate for Payer: Networks By Design Commercial |
$2,078.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,718.30
|
|
|
HC EP RF STJ SAFIRE ABLAT CATH
|
Facility
|
OP
|
$3,198.00
|
|
|
Service Code
|
CPT C1733
|
| Hospital Charge Code |
906812342
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$639.60 |
| Max. Negotiated Rate |
$6,862.04 |
| Rate for Payer: Adventist Health Commercial |
$639.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,862.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,718.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,758.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,398.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,548.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,860.28
|
| Rate for Payer: Blue Shield of California Commercial |
$2,027.53
|
| Rate for Payer: Blue Shield of California EPN |
$1,276.00
|
| Rate for Payer: Cash Price |
$1,439.10
|
| Rate for Payer: Cash Price |
$1,439.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,558.40
|
| Rate for Payer: Cigna of CA HMO |
$2,046.72
|
| Rate for Payer: Cigna of CA PPO |
$2,366.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,718.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,718.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,718.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,238.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,279.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,279.20
|
| Rate for Payer: Galaxy Health WC |
$2,718.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,918.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,878.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,030.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,160.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,886.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$639.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,238.60
|
| Rate for Payer: Multiplan Commercial |
$2,398.50
|
| Rate for Payer: Networks By Design Commercial |
$2,078.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,718.30
|
| Rate for Payer: Riverside University Health System MISP |
$1,279.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,918.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,918.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,599.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,599.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,599.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,599.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,718.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,718.30
|
| Rate for Payer: Vantage Medical Group Senior |
$2,718.30
|
|
|
HC EPS 3-D MAPPING
|
Facility
|
IP
|
$8,369.00
|
|
|
Service Code
|
CPT 93613
|
| Hospital Charge Code |
906812178
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,673.80 |
| Max. Negotiated Rate |
$7,532.10 |
| Rate for Payer: Adventist Health Commercial |
$1,673.80
|
| Rate for Payer: Cash Price |
$3,766.05
|
| Rate for Payer: Central Health Plan Commercial |
$6,695.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,858.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,347.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,347.60
|
| Rate for Payer: Galaxy Health WC |
$7,113.65
|
| Rate for Payer: Global Benefits Group Commercial |
$5,021.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,532.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,314.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,937.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,673.80
|
| Rate for Payer: Multiplan Commercial |
$6,276.75
|
| Rate for Payer: Networks By Design Commercial |
$5,439.85
|
| Rate for Payer: Prime Health Services Commercial |
$7,113.65
|
|
|
HC EPS 3-D MAPPING
|
Facility
|
OP
|
$8,369.00
|
|
|
Service Code
|
CPT 93613
|
| Hospital Charge Code |
906812178
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$537.57 |
| Max. Negotiated Rate |
$8,136.21 |
| Rate for Payer: Adventist Health Commercial |
$1,673.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$642.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,113.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,602.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,276.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$3,766.05
|
| Rate for Payer: Cash Price |
$3,766.05
|
| Rate for Payer: Cash Price |
$3,766.05
|
| Rate for Payer: Cash Price |
$3,766.05
|
| Rate for Payer: Central Health Plan Commercial |
$6,695.20
|
| Rate for Payer: Cigna of CA HMO |
$5,356.16
|
| Rate for Payer: Cigna of CA PPO |
$6,193.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,113.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,113.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,113.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,858.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,347.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,347.60
|
| Rate for Payer: Galaxy Health WC |
$7,113.65
|
| Rate for Payer: Global Benefits Group Commercial |
$5,021.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,532.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$537.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,314.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$593.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,937.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,673.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,858.30
|
| Rate for Payer: Multiplan Commercial |
$6,276.75
|
| Rate for Payer: Networks By Design Commercial |
$5,439.85
|
| Rate for Payer: Prime Health Services Commercial |
$7,113.65
|
| Rate for Payer: Riverside University Health System MISP |
$3,347.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,021.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,021.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,113.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,113.65
|
| Rate for Payer: Vantage Medical Group Senior |
$7,113.65
|
|
|
HC EPS ARRHYTHMIA INDUCTION
|
Facility
|
OP
|
$4,978.00
|
|
|
Service Code
|
CPT 93618
|
| Hospital Charge Code |
906811328
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$304.30 |
| Max. Negotiated Rate |
$8,136.21 |
| Rate for Payer: Adventist Health Commercial |
$995.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,565.96
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,053.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,348.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,722.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,565.96
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$2,240.10
|
| Rate for Payer: Cash Price |
$2,240.10
|
| Rate for Payer: Cash Price |
$2,240.10
|
| Rate for Payer: Cash Price |
$2,240.10
|
| Rate for Payer: Central Health Plan Commercial |
$3,982.40
|
| Rate for Payer: Cigna of CA HMO |
$3,185.92
|
| Rate for Payer: Cigna of CA PPO |
$3,683.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,348.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,722.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,565.96
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,484.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,583.83
|
| Rate for Payer: EPIC Health Plan Senior |
$1,722.56
|
| Rate for Payer: Galaxy Health WC |
$4,231.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,986.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,480.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,568.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$304.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,565.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,161.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$336.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,192.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$995.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,098.39
|
| Rate for Payer: Multiplan Commercial |
$3,733.50
|
| Rate for Payer: Networks By Design Commercial |
$3,235.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,565.96
|
| Rate for Payer: Prime Health Services Commercial |
$4,231.30
|
| Rate for Payer: Prime Health Services Medicare |
$1,659.92
|
| Rate for Payer: Riverside University Health System MISP |
$1,722.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,986.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,986.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,565.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,348.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,722.56
|
| Rate for Payer: Vantage Medical Group Senior |
$1,565.96
|
|
|
HC EPS ARRHYTHMIA INDUCTION
|
Facility
|
IP
|
$4,978.00
|
|
|
Service Code
|
CPT 93618
|
| Hospital Charge Code |
906811328
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$995.60 |
| Max. Negotiated Rate |
$4,480.20 |
| Rate for Payer: Adventist Health Commercial |
$995.60
|
| Rate for Payer: Cash Price |
$2,240.10
|
| Rate for Payer: Central Health Plan Commercial |
$3,982.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,484.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,991.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,991.20
|
| Rate for Payer: Galaxy Health WC |
$4,231.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,986.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,480.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,161.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,937.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$995.60
|
| Rate for Payer: Multiplan Commercial |
$3,733.50
|
| Rate for Payer: Networks By Design Commercial |
$3,235.70
|
| Rate for Payer: Prime Health Services Commercial |
$4,231.30
|
|
